36 results on '"Edfeldt, Katarina"'
Search Results
2. InCHARGE: Co-creating, implementing and evaluating interventions to utilize nurses' competence and achieve person-centred fundamental care—A research protocol describing an action research approach.
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Hauffman, Anna, Björk, Elin, Edfeldt, Katarina, Fröjd, Camilla, Gunnarsson, Anna-Karin, Nyholm, Lena, Avallin, Therese, and Jangland, Eva
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RESEARCH protocols ,ACTION research ,NURSING leadership ,NURSING interventions ,WORK environment ,NURSING home patients - Abstract
Aim and objectives: This research protocol presents an action research project with the aim to demonstrate the value of person-centred fundamental care to nurses and nurse managers in surgical care units to encourage a far-reaching change in this direction. The objectives are to describe this process and to evaluate the effects on missed nursing care and person-centred fundamental care. Methods: In a novel collaboration between nursing science and medical humanities the action research design will be used to interact with nursing staff and leaders in three surgical care units and design interventions with the purpose to affect the direction of nursing. Initially, the care units will be presented with interactive workshops including evidence-based education on person-centered fundamental care, person-centredness, nurse role responsibility and leadership. This will be followed by cocreation of interventions to stimulate person-centered fundamental care. The Fundamentals of Care framework will be used as the overarching theoretical framework. Data on missed nursing care, person-centred climate and person-centered fundamental care will be collected repeatedly from patient- and nursing stakeholders through interviews and validated questionnaires. Additionally, data from written reflections following clinical observations and focus group interviews will be included. The duration of the study will be approximately five years from ethical approval. Discussion: It has been previously reported that the current working environments of registered nurses are forcing them to ration their caring responsibilities, leading to a lack of fulfillment of patients' fundamental care needs, with possible severe consequences for patients. The action research design helps researchers gain an understanding of the contextual factors important for forthcoming interventions, enabling reflective processes and cocreation of interventions with stakeholders. This may lead to feasible interventions and strengthen nursing leadership in the involved units. [ABSTRACT FROM AUTHOR]
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- 2024
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- View/download PDF
3. Oral health and oral care in patients in a surgical context: A quantitative study comparing patients' and nurses' assessments.
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Edfeldt, Katarina, Jangland, Eva, Larsson Ingwall, Linn, Wistedt, Sandra‐Marie, Gunnarsson, Anna‐Karin, and Fröjd, Camilla
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SELF-evaluation , *NURSES , *SCALE analysis (Psychology) , *STATISTICAL correlation , *SURGERY , *PATIENTS , *RESEARCH funding , *NURSING assessment , *MEDICAL care , *HUMAN research subjects , *ORAL hygiene , *QUANTITATIVE research , *DESCRIPTIVE statistics , *RESEARCH methodology , *PAIN , *INFORMED consent (Medical law) , *STATISTICS , *MEDICAL needs assessment , *COMPARATIVE studies , *DEGLUTITION , *DATA analysis software , *ORAL health - Abstract
Aims: To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self‐reported oral health with registered nurse assessments. Design: A descriptive and comparative study, with a consecutive selection. Methods: A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement. Results: Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self‐assessment did. Conclusion: There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled. Implications for the Profession and Patient Care: Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self‐assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts. Impact: There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care. Patient Contribution: Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment. Reporting Method: This study was carried out according to the STROBE checklist. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
4. Improved health‐related quality of life during peptide receptor radionuclide therapy in patients with neuroendocrine tumours
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Edfeldt, Katarina, primary, Hellman, Per, additional, Granberg, Dan, additional, Lagergren, Pernilla, additional, Thiis‐Evensen, Espen, additional, Sundin, Anders, additional, and Andersson, Camilla, additional
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- 2023
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5. Effective learning activity to facilitate post-graduate nursing students' utilization of nursing theories - Using the fundamentals of care framework
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Jangland, Eva, Gunnarsson, Anna-Karin, Hauffman, Anna, Edfeldt, Katarina, Nyholm, Lena, Fröjd, Camilla, Jangland, Eva, Gunnarsson, Anna-Karin, Hauffman, Anna, Edfeldt, Katarina, Nyholm, Lena, and Fröjd, Camilla
- Abstract
AIMS: To explore how postgraduate nursing students used the Fundamentals of Care framework in a written assignment based on a clinical situation, and describe their learning process in using the framework. DESIGN: A qualitative descriptive study design applying the Fundamentals of Care framework. METHODS: Postgraduate nursing students' theoretical written assignments (n = 35) based on self-experienced clinical cases were included. The data were collected in 2021 in five specialties in a postgraduate nursing programme in Sweden. The data were analysed using content analysis. RESULTS: Applying the framework to a self-experienced clinical case illuminated the importance of nurse-patient relationships and clarified the meaning of person-centred care. The students assessed the framework as easy-to-use bedside as a guide to providing nursing care. By using the framework, the students were aided in reasoning about the fundamental values of care such as ethics, equality in healthcare and patient rights. When students reflected on their learning process, they stated that the assignment taught them how to use the framework, as well as paving the way for finding and applying other theories of nursing. CONCLUSION: Learning activities with an opportunity to practice analysing nursing care guided by a theory, combined with a self-evaluating element, are conducive to deepening students' learning and improving their ability to use theories in clinical practice. IMPACT: The framework illuminated the importance of the nurse-patient relationship in nursing care to the students and made them recognize and value the clinical use of theories. It is the responsibility of leaders in nurse education and healthcare to provide the next generation of specialist nurses-future nursing leaders-with regular opportunities to analyse nursing care through theories and frameworks. Nurses call for continuous learning on theories; leaders in nurse education and healthcare must meet these needs.
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- 2023
- Full Text
- View/download PDF
6. Improved health‐related quality of life during peptide receptor radionuclide therapy in patients with neuroendocrine tumours
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Edfeldt, Katarina, Hellman, Per, Granberg, Dan, Lagergren, Pernilla, Thiis‐Evensen, Espen, Sundin, Anders, Andersson, Camilla, Edfeldt, Katarina, Hellman, Per, Granberg, Dan, Lagergren, Pernilla, Thiis‐Evensen, Espen, Sundin, Anders, and Andersson, Camilla
- Abstract
Neuroendocrine tumours (NETs) can arise in different locations in the body, and may give rise to hormonal symptoms, which amongst other factors may affect patients' health-related quality of life (HRQoL). Up to four cycles of peptide receptor radionuclide therapy (PRRT) have been shown effective for symptom alleviation and prolonging progression-free survival. The aim of this study was to assess the patient's perspective regarding changes in their HRQoL during PRRT. HRQoL was assessed using the questionnaires for cancer in general, EORTC QLQ-C30, and the gastrointestinal NET-specifically EORTC QLQ-GINET21. Patients with NET (n = 204) rated their HRQoL before PRRT cycles one and four. The medical records of patients were reviewed and their HRQoL was compared to a matched reference population (n = 4910). HRQoL was found to improve during PRRT in aspects of global quality of life; role, social, and emotional functioning, and multiple symptom relief. Potential risk groups for worse HRQoL during PRRT were patients with overweight (BMI >25) who completed four cycles of PRRT and older patients (>65 years old). In conclusion, we found that PRRT improves HRQoL in patients with NETs. The results of this study may be used to improve person-centred care.
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- 2023
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7. Oral health and oral care in patients in a surgical context : A quantitative study comparing patients' and nurses' assessments
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Edfeldt, Katarina, Jangland, Eva, Larsson Ingwall, Linn, Wistedt, Sandra‐Marie, Gunnarsson, Anna-Karin, Fröjd, Camilla, Edfeldt, Katarina, Jangland, Eva, Larsson Ingwall, Linn, Wistedt, Sandra‐Marie, Gunnarsson, Anna-Karin, and Fröjd, Camilla
- Abstract
Aims To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self-reported oral health with registered nurse assessments. Design A descriptive and comparative study, with a consecutive selection. Methods A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement. Results Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self-assessment did. Conclusion There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled. Implications for the Profession and Patient Care Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self-assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts. Impact There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care. Patient Contributio
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- 2023
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8. Somatic Mutations and Genetic Heterogeneity at the CDKN1B Locus in Small Intestinal Neuroendocrine Tumors
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Crona, Joakim, Gustavsson, Tobias, Norlén, Olov, Edfeldt, Katarina, Åkerström, Tobias, Westin, Gunnar, Hellman, Per, Björklund, Peyman, and Stålberg, Peter
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- 2015
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9. Effective learning activity to facilitate post-graduate nursing students' utilization of nursing theories - Using the fundamentals of care framework.
- Author
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Jangland, Eva, Gunnarsson, Anna-Karin, Hauffman, Anna, Edfeldt, Katarina, Nyholm, Lena, Fröjd, Camilla, Jangland, Eva, Gunnarsson, Anna-Karin, Hauffman, Anna, Edfeldt, Katarina, Nyholm, Lena, and Fröjd, Camilla
- Abstract
AIMS: To explore how postgraduate nursing students used the Fundamentals of Care framework in a written assignment based on a clinical situation, and describe their learning process in using the framework. DESIGN: A qualitative descriptive study design applying the Fundamentals of Care framework. METHODS: Postgraduate nursing students' theoretical written assignments (n = 35) based on self-experienced clinical cases were included. The data were collected in 2021 in five specialties in a postgraduate nursing programme in Sweden. The data were analysed using content analysis. RESULTS: Applying the framework to a self-experienced clinical case illuminated the importance of nurse-patient relationships and clarified the meaning of person-centred care. The students assessed the framework as easy-to-use bedside as a guide to providing nursing care. By using the framework, the students were aided in reasoning about the fundamental values of care such as ethics, equality in healthcare and patient rights. When students reflected on their learning process, they stated that the assignment taught them how to use the framework, as well as paving the way for finding and applying other theories of nursing. CONCLUSION: Learning activities with an opportunity to practice analysing nursing care guided by a theory, combined with a self-evaluating element, are conducive to deepening students' learning and improving their ability to use theories in clinical practice. IMPACT: The framework illuminated the importance of the nurse-patient relationship in nursing care to the students and made them recognize and value the clinical use of theories. It is the responsibility of leaders in nurse education and healthcare to provide the next generation of specialist nurses-future nursing leaders-with regular opportunities to analyse nursing care through theories and frameworks. Nurses call for continuous learning on theories; leaders in nurse education and healthcare must meet these needs.
- Published
- 2022
- Full Text
- View/download PDF
10. Effective learning activity to facilitate post‐graduate nursing students' utilization of nursing theories – Using the fundamentals of care framework
- Author
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Jangland, Eva, primary, Gunnarsson, Anna‐Karin, additional, Hauffman, Anna, additional, Edfeldt, Katarina, additional, Nyholm, Lena, additional, and Fröjd, Camilla, additional
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- 2022
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11. Peritoneal carcinomatosis from small intestinal neuroendocrine tumors: Clinical course and genetic profiling
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Norlén, Olov, Edfeldt, Katarina, Akerstrom, Goran, Westin, Gunnar, Hellman, Per, Bjorklund, Peyman, and Stalberg, Peter
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- 2014
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12. Left-Shifted Relation between Calcium and Parathyroid Hormone in Obesity
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Hultin, Hella, Edfeldt, Katarina, Sundbom, Magnus, and Hellman, Per
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- 2010
13. Experiences and Fundamental Care Needs in Patients With Small Intestinal Neuroendocrine Tumours—An Interview Study in a Surgical Context.
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Olsson, Frida, Jangland, Eva, and Edfeldt, Katarina
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PATIENTS' attitudes , *PATIENT experience , *NURSES , *NURSING leadership , *LEADERSHIP - Abstract
ABSTRACT Aims Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient Contribution The study aimed to describe patients' fundamental care needs and their experiences of nursing care, throughout surgical treatment of small intestinal neuroendocrine tumours.A qualitative descriptive study was performed.Patients' interviews (n = 19) were conducted in Sweden from May 2021 to January 2022 and analysed using directed qualitative content analysis guided by the Fundamentals of Care framework.The results are presented in three descriptive categories chronologically throughout the care chain. In the preoperative phase of care, the category was ‘Feeling safe but lonely and frightened, and struggling with existential thoughts’; experiences in the postoperative phase of care resulted in the category ‘Feeling cared for but suffering from physical symptoms and feelings of loneliness’; and the category in the discharge phase was ‘Lacking self‐care information and feeling worried about the future’.There were deficiencies in the delivery of fundamental care for patients with a rare tumour diagnosis throughout surgical treatment. Nursing care is mostly task focused and fragmented, and there is a lack of psychosocial and relational care across the care chain. Registered nurses and nursing managers need to take responsibility for their leadership in nursing care to fulfil patients' fundamental care needs. The Fundamentals of Care framework could be used for work improvements to include all aspects of nursing care. High‐quality nursing care is needed throughout the care chain, including self‐care after discharge, for patients with this rare tumour diagnosis. A higher awareness of patients' experiences and the importance of psychosocial support is warranted. Registered nurses and nursing managers must revise and improve routines to support patients' psychosocial needs. Registered nurses need to take responsibility for their leadership in nursing care to fulfil patients' fundamental care needs. What problem did the study address? This study highlights patients' fundamental care needs and experiences of nursing care throughout surgical treatment of small intestinal neuroendocrine tumours.What were the main findings? There are deficiencies in fulfilling patients' fundamental care needs across the care chain and in all dimensions of the Fundamental of Care framework throughout surgical treatment of small intestinal neuroendocrine tumours. Patients struggled with loneliness and existential thoughts, as well as worries about the future. Patients experienced a lack of information about plans for the day, self‐care, and follow‐ups.Where and on whom will the research have an impact? For clinicians to develop an understanding of, and improve, fundamental care needs for patients with small intestinal neuroendocrine tumours in a surgical context. For registered nurses to understand the importance of their leadership and nursing responsibility to fulfil fundamental care needs.The consolidated criteria for reporting qualitative research (COREQ): a 32‐item checklist for interviews and focus groups.The patients shared their experiences during the interviews, which has contributed to a deeper knowledge and understanding of the phenomena under study. [ABSTRACT FROM AUTHOR]
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- 2024
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14. DcR3, TFF3 and Midkine are Novel Serum Biomarkers in Small Intestinal Neuroendocrine Tumors
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Edfeldt, Katarina, Daskalakis, Kosmas, Bäcklin, Christofer, Norlén, Olov, Tiensuu Janson, Eva, Westin, Gunnar, Hellman, Per, Stålberg, Peter, Edfeldt, Katarina, Daskalakis, Kosmas, Bäcklin, Christofer, Norlén, Olov, Tiensuu Janson, Eva, Westin, Gunnar, Hellman, Per, and Stålberg, Peter
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Small intestinal neuroendocrine tumors (SI-NETs) are amine- and peptide producing neoplasms. Most patients display metastases at the time of diagnosis, they have an unpredictable individual disease course and the tumors are often therapy resistant. Chromogranin A (CgA) and 5-hydroxyindoleacetic acid (5-HIAA) are the clinically most used biomarkers today, but there is a great need for novel diagnostic and prognostic biomarkers and new therapeutic targets. Sixty-nine biomarkers were screened in serum from 23 SI-NET patients and 23 healthy controls using multiplex PLA (proximity ligation assay). A refined method, PEA (proximity extension assay), was used to analyze 76 additional biomarkers. Statistical testing and multivariate classification were performed. Immunohistochemistry and ELISA assays were performed in an extended cohort. Using PLA, 19 biomarkers showed a significant difference in serum concentrations between patients and controls, and PEA revealed difference in concentrations in 13 proteins. Multivariate classification analysis revealed decoy receptor 3 (DcR3), trefoil factor 3 (TFF3) and Midkine to be good biomarkers for disease, which was confirmed by ELISA analysis. All three biomarkers were expressed in tumor tissue. DcR3 concentrations were elevated in patients with stage IV disease. High concentrations of DcR3 and TFF3 were correlated to poor survival. DcR3, TFF3 and Midkine exhibited elevated serum concentrations in SI-NET patients compared to healthy controls, and DcR3 and TFF3 were associated with poor survival. DcR3 seems to be a marker for liver metastases while TFF3 and Midkine may be new diagnostic biomarkers for SI-NETs.
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- 2017
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15. DcR3, TFF3, and Midkine Are Novel Serum Biomarkers in Small Intestinal Neuroendocrine Tumors
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Edfeldt, Katarina, primary, Daskalakis, Kosmas, additional, Bäcklin, Christofer, additional, Norlén, Olov, additional, Tiensuu Janson, Eva, additional, Westin, Gunnar, additional, Hellman, Per, additional, and Stålberg, Peter, additional
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- 2016
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16. A plausible role for actin gamma smooth muscle 2 (ACTG2) in small intestinal neuroendocrine tumorigenesis
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Edfeldt, Katarina, Hellman, Per, Westin, Gunnar, Stålberg, Peter, Edfeldt, Katarina, Hellman, Per, Westin, Gunnar, and Stålberg, Peter
- Abstract
BACKGROUND: Small intestinal neuroendocrine tumors (SI-NETs) originate from the enterochromaffin cells in the ileum and jejunum. The knowledge about genetic and epigenetic abnormalities is limited. Low mRNA expression levels of actin gamma smooth muscle 2 (ACTG2) have been demonstrated in metastases relative to primary SI-NETs. ACTG2 and microRNA-145 (miR-145) are aberrantly expressed in other cancers and ACTG2 can be induced by miR-145. The aim of this study was to investigate the role of ACTG2 in small intestinal neuroendocrine tumorigenesis. METHODS: Protein expression was analyzed in SI-NETs (n = 24) and in enterochromaffin cells by immunohistochemistry. The cell line CNDT2.5 was treated with the histone methyltransferase inhibitor 3-deazaneplanocin A (DZNep), the selective EZH2 inhibitor EPZ-6438, or 5-aza-2'-deoxycytidine, a DNA hypomethylating agent. Cells were transfected with ACTG2 expression plasmid or miR-145. Western blotting analysis, quantitative RT-PCR, colony formation- and viability assays were performed. miR-145 expression levels were measured in tumors. RESULTS: Eight primary tumors and two lymph node metastases displayed variable levels of positive staining. Fourteen SI-NETs and normal enterochromaffin cells stained negatively. Overexpression of ACTG2 significantly inhibited CNDT2.5 cell growth. Treatment with DZNep or transfection with miR-145 induced ACTG2 expression (>10-fold), but no effects were detected after treatment with EPZ-6438 or 5-aza-2'-deoxycytidine. DZNep also induced miR-145 expression. SI-NETs expressed relatively low levels of miR-145, with reduced expression in metastases compared to primary tumors. CONCLUSIONS: ACTG2 is expressed in a fraction of SI-NETs, can inhibit cell growth in vitro, and is positively regulated by miR-145. Theoretical therapeutic strategies based on these results are discussed.
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- 2016
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17. Midkine Is a New Novel Serum Biomarker in Small Intestinal Neuroendocrine Tumors (SI-NETs)
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Daskalakis, Kosmas, Edfeldt, Katarina, Norlén, Olov, Karakatsanis, Andreas, Backlin, Carin, Tiensuu Janson, Eva, Westin, Gunnar, Hellman, Per, Stålberg, Peter, Daskalakis, Kosmas, Edfeldt, Katarina, Norlén, Olov, Karakatsanis, Andreas, Backlin, Carin, Tiensuu Janson, Eva, Westin, Gunnar, Hellman, Per, and Stålberg, Peter
- Published
- 2016
18. Small Intestinal Neuroendocrine Tumours : Genetic and Epigenetic Studies and Novel Serum Biomarkers
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Edfeldt, Katarina
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Medicin och hälsovetenskap ,Medicinska och farmaceutiska grundvetenskaper ,serum biomarkers ,Basic Medicine ,SI-NET ,tumour suppressor gene ,microarray ,Medical and Health Sciences ,epigenetic - Abstract
Small intestinal neuroendocrine tumours (SI-NETs) are rare, hormone producing and proliferate slowly. Patients usually display metastases at time of diagnosis, the tumours are difficult to cure, and the disease course is unpredictable. The gene expression pattern was investigated in paper I, with emphasis on aggressive disease and tumour progression. Expression microarrays were performed on 42 tumours. Unsupervised hierarchal clustering revealed three clusters that were correlated to clinical features, and expression changes from primary tumour to metastasis. Eight novel genes, ACTG2, GREM2, REG3A, TUSC2, RUNX1, TGFBR2, TPH1 and CDH6 may be of importance for tumour progression. In paper II, expression of ACTG2 was detected in a fraction of SI-NETs, but not in normal enterochromaffin cells. Inhibition of histone methyltransferase and transfection of miR-145 induced expression and no effect was seen after DNA methylation or selective EZH2 inhibition in vitro. miR-145 expression was reduced in metastases compared to primary tumours. Overexpression of ACTG2 inhibited cell growth, and inducing ACTG2 may have therapeutic effects. TCEB3C (Elongin A3) is located on chromosome 18 and is imprinted in some tissues. In paper III a reduced protein expression was detected. The gene was epigenetically repressed by both DNA and histone methylation in a tumour tissue specific context. The expression was also induced in primary cell cultures after DNA demethylation and pyrosequencing revealed promoter region hypermethylation. Overexpression of TCEB3C inhibited cell growth by 50%, suggesting TCEB3C to be a tumour suppressor gene. In paper IV, 69 biomarkers were analysed in blood serum using multiplex proximity ligation assay. Nineteen markers displayed different levels between patients and controls. In an extended cohort, ELISA analysis showed elevated serum levels of Mindin, DcR3 and TFF3 in patients and protein expression in tumour cells. High levels of DcR3 and TFF3 were associated with poor survival, and DcR3 may be a marker for liver metastases. Mindin, DcR3, and TFF3 are potential novel diagnostic biomarkers for SI-NETs.
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- 2014
19. A plausible role for actin gamma smooth muscle 2 (ACTG2) in small intestinal neuroendocrine tumorigenesis
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Edfeldt, Katarina, primary, Hellman, Per, additional, Westin, Gunnar, additional, and Stalberg, Peter, additional
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- 2016
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20. A review on management discussions of small intestinal neuroendocrine tumors 'midgut carcinoids'
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Åkerström, Göran, Norlén, Olov, Edfeldt, Katarina, Crona, Joakim, Björklund, Peyman, Westin, Gunnar, Hellman, Per, Stålberg, Peter, Åkerström, Göran, Norlén, Olov, Edfeldt, Katarina, Crona, Joakim, Björklund, Peyman, Westin, Gunnar, Hellman, Per, and Stålberg, Peter
- Abstract
European Neuroendocrine Tumor Society staging, together with the Ki67 grading system, has appeared as superior for classification of neuroendocrine tumors (NET). The management of small intestinal NET (SI-NET) has been overall controversial. Mesenteric metastases occur also with the smallest SI-NET, and the majority of patients risk to ultimately progress with liver metastases. 68Gallium (somatostatin receptor)/PET/CT has appeared as most sensitive for imaging, and fluorodeoxyglucose-PET is recommended to identify lesions with high proliferation. Our treatment policy for SINET is to initiate somatostatin analog treatment, and in order to prevent abdominal complications we recommend early intestinal resection for removal of primary tumors and clearance of lymph node metastases. Liver metastases are liberally treated by resection (or ablation), as this can efficiently palliate carcinoid syndrome-associated symptoms.
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- 2015
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21. A review on management discussions of small intestinal neuroendocrine tumors ‘midgut carcinoids’
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Åkerström, Göran, primary, Norlén, Olov, additional, Edfeldt, Katarina, additional, Crona, Joakim, additional, Björklund, Peyman, additional, Westin, Gunnar, additional, Hellman, Per, additional, and Stålberg, Peter, additional
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- 2015
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22. TCEB3C a putative tumor suppressor gene of small intestine neuroendocrine tumors
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Edfeldt, Katarina, Ahmad, Tanveer, Åkerström, Göran, Janson, Eva T, Hellman, Per, Stålberg, Peter, Björklund, Peyman, Westin, Gunnar, Edfeldt, Katarina, Ahmad, Tanveer, Åkerström, Göran, Janson, Eva T, Hellman, Per, Stålberg, Peter, Björklund, Peyman, and Westin, Gunnar
- Abstract
Small intestinal neuroendocrine tumors (SI-NETs), formerly midgut carcinoids, are rare and slow-growing neoplasms. Frequent loss of one copy of chromosome 18 in primary tumors and metastases has been observed. The aim of the study was to investigate a possible role of TCEB3C (Elongin A3), currently the only imprinted gene on chromosome 18, as a tumor suppressor gene in SI-NETs, and whether its expression is epigenetically regulated. Primary tumors, metastases, the human SI-NET cell line CNDT2.5, and two other cell lines were included. Immunohistochemistry, gene copy number determination by PCR, colony formation assay, Western blotting, real-time quantitative RT-PCR, RNA interference, and quantitative CpG methylation analysis by pyrosequencing were performed. The large majority of tumors (33/43) showed very low to undetectable Elongin A3 expression and as expected 89% (40/45) displayed one TCEB3C gene copy. The DNA hypomethylating agent 5-aza-2'-deoxycytidine induced TCEB3C expression in CNDT2.5 cells, in primary SI-NET cells prepared directly after surgery, but not in two other cell lines. Also siRNA to DNMT1 and treatment with the general histone methyltransferase inhibitor 3-deazaneplanocin A induced TCEB3C expression in a cell type-specific way. CpG methylation at the TCEB3C promoter was observed in all analyzed tissues and thus not related to expression. Overexpression of TCEB3C resulted in a 50% decrease of clonogenic survival of CNDT2.5 cells, but not of control cells. The results support a putative role of TCEB3C as a tumor suppressor gene in SI-NETs. Epigenetic repression of TCEB3C seems to be tumor cell type-specific and involves both DNA and histone methylation.
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- 2014
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23. ACTG2 Inhibits Growth and Is Epigenetically Repressed in Small Intestinal Neuroendocrine Tumors
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Edfeldt, Katarina, Hellman, Per, Westin, Gunnar, Stalberg, Peter, Edfeldt, Katarina, Hellman, Per, Westin, Gunnar, and Stalberg, Peter
- Published
- 2014
24. TCEB3C (Elongin A3) on chromosome 18 presents a putative tumor suppressor gene of small intestine neuroendocrine tumors.
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Edfeldt, Katarina, Ahmad, Tanvver, Åkerstrom, Göran, Janson, Eva Tiensuu, Hellman, Per, Stalberg, Peter, Björklund, Peyman, Westin, Gunnar, Edfeldt, Katarina, Ahmad, Tanvver, Åkerstrom, Göran, Janson, Eva Tiensuu, Hellman, Per, Stalberg, Peter, Björklund, Peyman, and Westin, Gunnar
- Published
- 2013
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25. TCEB3C a putative tumor suppressor gene of small intestinal neuroendocrine tumors
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Edfeldt, Katarina, primary, Ahmad, Tanveer, additional, Åkerström, Göran, additional, Janson, Eva Tiensuu, additional, Hellman, Per, additional, Stålberg, Peter, additional, Björklund, Peyman, additional, and Westin, Gunnar, additional
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- 2013
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26. Different gene expression profiles in metastasizing midgut carcinoid tumors
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Edfeldt, Katarina, Björklund, Peyman, Åkerström, Göran, Westin, Gunnar, Hellman, Per, Stålberg, Peter, Edfeldt, Katarina, Björklund, Peyman, Åkerström, Göran, Westin, Gunnar, Hellman, Per, and Stålberg, Peter
- Abstract
The genetic events leading the progression of midgut carcinoid tumors are largely unknown. The disease course varies from patient to patient, and there is a lack of reliable prognostic markers. In order to identify genes involved in tumor progression, gene expression profiling was performed on tumor specimens. Samples comprised 18 primary tumors, 17 lymph node (LN) metastases, and seven liver metastases from a total of 19 patients. Patients were grouped according to clinical data and histopathology into indolent or progressive course. RNA was subjected to a spotted oligo microarray and B-statistics were performed. Differentially expressed genes were verified using quantitative real-time PCR. Self-organizing maps demonstrated three clusters: 11 primary tumors separated in one cluster, five LN metastases in another cluster, whereas all seven liver metastases, seven primary, and 12 LN metastases formed a third cluster. There was no correlation between indolent and progressive behavior. The primary tumors with Ki67>5%, with low frequency of the carcinoid syndrome, and a tendency toward shorter survival grouped together. Primary tumors differed in expression profile from their associated LN metastases; thus, there is evidence for genetic changes from primary tumors to metastases. ACTG2, GREM2, REG3A, TUSC2, RUNX1, TPH1, TGFBR2, and CDH6 were differentially expressed between clusters and subgroups of tumors. The expression profile that assembles tumors as being genetically similar on the RNA expression level may not be concordant with the clinical disease course. This study reveals differences in gene expression profiles and novel genes that may be of importance in midgut carcinoid tumor progression.
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- 2011
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27. Neurogenin 3 and neurogenic differentiation 1 are retained in the cytoplasm of multiple endocrine neoplasia type 1 islet and pancreatic endocrine tumor cells
- Author
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Lejonklou, Margareta Halin, Edfeldt, Katarina, Johansson, Térèse A., Stålberg, Peter, Skogseid, Britt, Lejonklou, Margareta Halin, Edfeldt, Katarina, Johansson, Térèse A., Stålberg, Peter, and Skogseid, Britt
- Abstract
OBJECTIVES: To investigate if transcription factors involved in pancreatic differentiation and regeneration are present in pancreatic endocrine tumors and if they are differentially expressed in normal pancreas compared with multiple endocrine neoplasia type 1 (MEN1) nontumorous pancreas. METHODS: The expression of neurogenin 3 (NEUROG3), neurogenic differentiation 1 (NEUROD1), POU class 3 homeobox 4 (POU3F4), pancreatic duodenal homeobox factor 1 (PDX1), ribosomal protein L10 (RPL10), delta-like 1 homolog (Drosophila; DLK1), and menin was analyzed by immunohistochemistry in normal pancreas and pancreatic endocrine tumors from 6 patients with MEN1 and 16 patients with sporadic tumors, as well as pancreatic specimens from Men1 heterozygous and wild type mice. Quantitative polymerase chain reaction was performed in a subset of human tumors. RESULTS: Tumors and MEN1 nontumorous endocrine cells showed a prominent cytoplasmatic NEUROG3 and NEUROD1 expression. These factors were significantly more expressed in the cytoplasm of Men1 heterozygous mouse islet cells compared with wild type islets; the latter showed an exclusively nuclear reactivity. The degree of Pou3f4, Rpl10, and Dlk1 immunoreactivities differed significantly between islets of heterozygous and wild type mice. The expressions of RPL10 and NEUROD1 were prominent in the MEN1 human and heterozygous mouse exocrine pancreas. Insulinomas had significantly higher PDX1 and DLK1 messenger RNA levels compared with other tumor types. CONCLUSIONS: Transcription factors involved in pancreatic development show altered expression and subcellular localization in MEN1 nontumorous pancreas and pancreatic endocrine tumors.
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- 2009
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28. Abstract 1982: TCEB3C (Elongin A3) on chromosome 18 presents a putative tumor suppressor gene of small intestine neuroendocrine tumors.
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Edfeldt, Katarina, primary, Ahmad, Tanvver, additional, Åkerström, Göran, additional, Tiensuu Janson, Eva, additional, Hellman, Per, additional, Stålberg, Peter, additional, Björklund, Peyman, additional, and Westin, Gunnar, additional
- Published
- 2013
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29. Different gene expression profiles in metastasizing midgut carcinoid tumors
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Edfeldt, Katarina, primary, Björklund, Peyman, additional, Åkerström, Göran, additional, Westin, Gunnar, additional, Hellman, Per, additional, and Stålberg, Peter, additional
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- 2011
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30. Neurogenin 3 and Neurogenic Differentiation 1 are Retained in the Cytoplasm of Multiple Endocrine Neoplasia Type 1 Islet and Pancreatic Endocrine Tumor Cells
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Lejonklou, Margareta H., primary, Edfeldt, Katarina, additional, Johansson, Térèse A., additional, Stålberg, Peter, additional, and Skogseid, Britt, additional
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- 2009
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31. TFF3 in primary tumours has a negative impact on survival in small intestinal neuroendocrine tumours
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Eriksson, John, Juhlin, Christofer, Backman, Samuel, Edfeldt, Katarina, Stålberg, Peter, Garmo, Hans, Ihre-Lundgren, Catharina, Hellman, Per, Eriksson, John, Juhlin, Christofer, Backman, Samuel, Edfeldt, Katarina, Stålberg, Peter, Garmo, Hans, Ihre-Lundgren, Catharina, and Hellman, Per
32. A Plausible Role for Actin Gamma Smooth Muscle 2 (ACTG2) in Small Intestinal Neuroendocrine Tumorgenesis
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Edfeldt, Katarina, Hellman, Per, Westin, Gunnar, Stålberg, Peter, Edfeldt, Katarina, Hellman, Per, Westin, Gunnar, and Stålberg, Peter
33. Novel Serum Biomarkers in Small Intestinal Neuroendocrine Tumors
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Edfeldt, Katarina, Bäcklin, Christofer, Tiensuu Janson, Eva, Westin, Gunnar, Hellman, Per, Stålberg, Peter, Edfeldt, Katarina, Bäcklin, Christofer, Tiensuu Janson, Eva, Westin, Gunnar, Hellman, Per, and Stålberg, Peter
34. Effective learning activity to facilitate post-graduate nursing students' utilization of nursing theories - Using the fundamentals of care framework.
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Jangland E, Gunnarsson AK, Hauffman A, Edfeldt K, Nyholm L, and Fröjd C
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- Humans, Nursing Theory, Learning, Education, Nursing, Baccalaureate, Students, Nursing, Nursing Care
- Abstract
Aims: To explore how postgraduate nursing students used the Fundamentals of Care framework in a written assignment based on a clinical situation, and describe their learning process in using the framework., Design: A qualitative descriptive study design applying the Fundamentals of Care framework., Methods: Postgraduate nursing students' theoretical written assignments (n = 35) based on self-experienced clinical cases were included. The data were collected in 2021 in five specialties in a postgraduate nursing programme in Sweden. The data were analysed using content analysis., Results: Applying the framework to a self-experienced clinical case illuminated the importance of nurse-patient relationships and clarified the meaning of person-centred care. The students assessed the framework as easy-to-use bedside as a guide to providing nursing care. By using the framework, the students were aided in reasoning about the fundamental values of care such as ethics, equality in healthcare and patient rights. When students reflected on their learning process, they stated that the assignment taught them how to use the framework, as well as paving the way for finding and applying other theories of nursing., Conclusion: Learning activities with an opportunity to practice analysing nursing care guided by a theory, combined with a self-evaluating element, are conducive to deepening students' learning and improving their ability to use theories in clinical practice., Impact: The framework illuminated the importance of the nurse-patient relationship in nursing care to the students and made them recognize and value the clinical use of theories. It is the responsibility of leaders in nurse education and healthcare to provide the next generation of specialist nurses-future nursing leaders-with regular opportunities to analyse nursing care through theories and frameworks. Nurses call for continuous learning on theories; leaders in nurse education and healthcare must meet these needs., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)
- Published
- 2023
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35. DcR3, TFF3, and Midkine Are Novel Serum Biomarkers in Small Intestinal Neuroendocrine Tumors.
- Author
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Edfeldt K, Daskalakis K, Bäcklin C, Norlén O, Tiensuu Janson E, Westin G, Hellman P, and Stålberg P
- Subjects
- Biomarkers, Tumor blood, Enzyme-Linked Immunosorbent Assay, Female, Follow-Up Studies, Humans, Immunohistochemistry, Intestinal Neoplasms pathology, Intestine, Small pathology, Liver Neoplasms blood, Liver Neoplasms secondary, Male, Middle Aged, Midkine, Multivariate Analysis, Neoplasm Staging, Neuroendocrine Tumors pathology, Prognosis, Survival Analysis, Cytokines blood, Intestinal Neoplasms blood, Neuroendocrine Tumors blood, Receptors, Tumor Necrosis Factor, Member 6b blood, Trefoil Factor-3 blood
- Abstract
Small intestinal neuroendocrine tumors (SI-NETs) are amine- and peptide-producing neoplasms. Most patients display metastases at the time of diagnosis; they have an unpredictable individual disease course and the tumors are often therapy resistant. Chromogranin A and 5-hydroxyindoleacetic acid are the biomarkers clinically used most often today, but there is a great need for novel diagnostic and prognostic biomarkers and new therapeutic targets. Sixty-nine biomarkers were screened in serum from 23 SI-NET patients and 23 healthy controls using the multiplex proximity ligation assay (PLA). A refined method, the proximity extension assay (PEA), was used to analyze 76 additional biomarkers. Statistical testing and multivariate classification were performed. Immunohistochemistry and ELISA were performed in an extended cohort. Using PLA, 19 biomarkers showed a significant difference in serum concentrations between patients and controls, and PEA revealed a difference in the concentrations of 17 proteins. Multivariate classification analysis revealed decoy receptor 3 (DcR3), trefoil factor 3 (TFF3), and midkine to be good biomarkers for the disease, which was confirmed by ELISA analysis. All 3 biomarkers were expressed in tumor tissue. DcR3 concentrations were elevated in patients with stage IV disease. High concentrations of DcR3 and TFF3 were correlated to poor survival. DcR3, TFF3, and midkine exhibited elevated serum concentrations in SI-NET patients compared to healthy controls, and DcR3 and TFF3 were associated with poor survival. DcR3 seems to be a marker for liver metastases, while TFF3 and midkine may be new diagnostic biomarkers for SI-NETs., (© 2016 S. Karger AG, Basel.)
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- 2017
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36. TCEB3C a putative tumor suppressor gene of small intestinal neuroendocrine tumors.
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Edfeldt K, Ahmad T, Åkerström G, Janson ET, Hellman P, Stålberg P, Björklund P, and Westin G
- Subjects
- Cell Line, Tumor, CpG Islands, Elongin, Genes, Tumor Suppressor, Histones metabolism, Humans, Intestinal Neoplasms metabolism, Intestine, Small, Methylation, Neuroendocrine Tumors metabolism, Promoter Regions, Genetic, Intestinal Neoplasms genetics, Neuroendocrine Tumors genetics, Transcription Factors genetics
- Abstract
Small intestinal neuroendocrine tumors (SI-NETs), formerly known as midgut carcinoids, are rare and slow-growing neoplasms. Frequent loss of one copy of chromosome 18 in primary tumors and metastases has been observed. The aim of the study was to investigate a possible role of TCEB3C (Elongin A3), currently the only imprinted gene on chromosome 18, as a tumor suppressor gene in SI-NETs, and whether its expression is epigenetically regulated. Primary tumors, metastases, the human SI-NET cell line CNDT2.5, and two other cell lines were included. Immunohistochemistry, gene copy number determination by PCR, colony formation assay, western blotting, real-time quantitative RT-PCR, RNA interference, and quantitative CpG methylation analysis by pyrosequencing were performed. A large majority of tumors (33/43) showed very low to undetectable Elongin A3 expression and as expected 89% (40/45) displayed one gene copy of TCEB3C. The DNA hypomethylating agent 5-aza-2'-deoxycytidine induced TCEB3C expression in CNDT2.5 cells, in primary SI-NET cells prepared directly after surgery, but not in two other cell lines. Also siRNA to DNMT1 and treatment with the general histone methyltransferase inhibitor 3-deazaneplanocin A induced TCEB3C expression in a cell type-specific way. CpG methylation at the TCEB3C promoter was observed in all analyzed tissues and thus not related to expression. Overexpression of TCEB3C resulted in a 50% decrease in clonogenic survival of CNDT2.5 cells, but not of control cells. The results support a putative role of TCEB3C as a tumor suppressor gene in SI-NETs. Epigenetic repression of TCEB3C seems to be tumor cell type-specific and involves both DNA and histone methylation.
- Published
- 2014
- Full Text
- View/download PDF
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